- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,107.29 / $2,747.00 / $4,806.64
| Facility | | $1,107.29 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.75 / $1,107.29 / $1,411.55
| Professional | | $804.75 | $1,107.29 | $1,411.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,854.00 / $6,733.25
| Facility | | $822.00 | $2,854.00 | $6,733.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,204.16 / $1,985.85 / $7,680.91
| Professional | | $1,204.16 | $1,985.85 | $7,680.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $680.00 / $748.00
| Facility | | $50.00 | $680.00 | $748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.10 / $1,109.10 / $1,428.40
| Professional | | $1,109.10 | $1,109.10 | $1,428.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.38 / $1,909.00 / $8,090.00
| Facility | | $1,207.38 | $1,909.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,385.47 / $1,750.70 / $2,571.71
| Professional | | $1,385.47 | $1,750.70 | $2,571.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,526.58 / $2,989.04 / $3,802.10
| Professional | | $1,526.58 | $2,989.04 | $3,802.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,189.67 / $6,733.25
| Facility | | $822.00 | $2,189.67 | $6,733.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.83 / $2,090.27 / $7,680.91
| Professional | | $1,266.83 | $2,090.27 | $7,680.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,446.00 / $4,050.00
| Facility | | $789.00 | $2,446.00 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,206.73 / $1,754.91 / $4,108.20
| Professional | | $1,206.73 | $1,754.91 | $4,108.20 |